Nursing Management of Heart Failure

A complete set of flashcards covering the etiology, pathophysiology, clinical manifestations, nursing management, and interventions for heart failure and cardiac transplantation.

What is the clinical definition of heart failure (HF)?

An abnormal clinical syndrome involving impaired cardiac pumping or filling, or both, characterized by ventricular dysfunction, reduced exercise tolerance, and diminished quality of life.

In Canada, what are the primary risk factors for heart failure and their respective percentages?

Coronary artery disease (CAD), responsible for up to $45\%$ of patients, and hypertension, responsible for $27.5\%$ of patients.

What characterizes Heart Failure with Reduced Ejection Fraction (HFrEF)?

It results from an inability of the heart to pump blood effectively, with a hallmark reduction in left ventricular ejection fraction (EF) typically categorized as $40\%$ or lower.

How is Heart Failure with Preserved Ejection Fraction (HFpEF) defined and diagnosed?

It involves the inability of the ventricles to relax and fill during diastole, diagnosed by the presence of HF symptoms with an ejection fraction (EF) of $50\%$ or greater.

What are the four main compensatory mechanisms used by the heart to maintain cardiac output (CO)?

(a) Sympathetic nervous system (SNS) activation, (b) neurohormonal responses, (c) ventricular dilation, and (d) ventricular hypertrophy.

How does the renin–angiotensin–aldosterone system (RAAS) contribute to heart failure pathophysiology?

Kidneys release renin in response to low cardiac output, converting angiotensinogen to angiotensin I and then II, which triggers the release of aldosterone, causing sodium and water retention.

What is the effect of Antidiuretic Hormone (ADH) secretion in heart failure?

Secreted by the posterior pituitary due to low cerebral perfusion, ADH increases water reabsorption in the kidneys, leading to increased blood volume when a volume overload state already exists.

What is ventricular remodelling?

A process involving hypertrophy of ventricular myocytes where cells become enlarged and abnormally shaped, leading to increased ventricular mass, wall tension, and impaired contractility.

What are the counterregulatory renal effects of natriuretic peptides (ANP and BNP)?

They increase the glomerular filtration rate, promote diuresis, and cause the excretion of sodium (natriuresis).

What is the most common form of initial heart failure and its primary consequence?

Left-sided heart failure is the most common, resulting in blood backing up through the left atrium into the pulmonary veins, causing pulmonary congestion and edema.

What are the clinical signs of right-sided heart failure?

Peripheral edema, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and jugular venous distension.

Define Paroxysmal Nocturnal Dyspnea (PND).

The patient awakens in a panic with feelings of suffocation and a desire to sit up, caused by the reabsorption of fluid from dependent body areas when lying flat.

What weight gain parameters should a patient with chronic heart failure report to their healthcare provider?

A gain of more than $1.5\,kg$ over $1\text{ to }2\text{ days}$ or $2.5\,kg$ in a single week.

According to the NYHA classification, what characterizes Class III heart failure?

Marked limitation of physical activity where the patient is usually comfortable at rest, but ordinary physical activity causes fatigue, dyspnea, palpitations, or anginal pain.

What is the purpose of biventricular pacing in Cardiac Resynchronization Therapy (CRT)?

It coordinates the contractility of the right and left ventricles to improve left ventricular performance, cardiac output, and exercise capacity.

What medications constitute the 'triple therapy' recommended for patients with HFrEF?

An ACE inhibitor (or ARB if intolerant), a $\beta$-adrenergic blocker, and a mineralocorticoid receptor antagonist (MRA).

Which loop diuretic is commonly used by direct intravenous (IV) route to rapidly decrease intravascular volume in acute HF?

Furosemide (Lasix).

What are the dietary sodium and fluid restrictions recommended by the Heart and Stroke Foundation of Canada for HF patients?

Sodium intake should be restricted to $2\,g/\text{day}$ ($1.5\,g/\text{day}$ if hypertensive), and fluid intake restricted to $1.5\text{ to }2\,L/\text{day}$.

What is the maximum acceptable ischemic time for a cardiac donor heart?

The maximum acceptable ischemic time for cardiac transplantation is $4\text{ to }6\text{ hours}$.

What are the major causes of death in the first year after a cardiac transplantation?

Acute rejection, infection, and sudden cardiac death.